Efficacy of a county-wide schools weight management intervention.

AIMS: This study aimed to evaluate the effectiveness of the Local Authority commissioned large-scale public health service that provided a 6-week school-based weight management intervention for children aged 4-19 years. METHODS: A quantitative retrospective cohort study identified participants from 130 schools consisting of 8550 potential children aged 4-19 years across a mixture of Lower Super Output Area (LSOA) deprivation groups. Participants were invited to take part in a 5- to 12-week Healthy Lifestyles intervention with a focus on weight management delivered by OneLife Suffolk between 1 January 2017 and 1 January 2020. This resulted in a final sample of 5163 participants. The following information for each child was collected anonymously: (1) age, (2) gender, (3) preprogramme body mass index (BMI), (4) postprogramme BMI, (5) weight category and (6) LSOA category. RESULTS: Following the 6-week school-based intervention, there was a significant decrease in mean ΔBMI SDS (standardised body mass index) of -0.07 (-14.89%) among participants. Wilcoxon signed-rank test showed a significant change in weight status post 6-week weight management programme (WMP): BMI (Z = -15.87, p < .001), BMI SDS (Z = -21.54, p < .001), centile (Z = -20.12, p < .01) and weight category (Z = -7.89, p < .001), whereas Mann-Whitney U test showed no statistically significant difference in mean BMI SDS change between gender groups (p = .24) and Kruskal-Wallis test revealed no statistically significant differences in mean BMI SDS change between child LSOA groups (c2(4) = 1.67, p = .796), school LSOA groups (c2(4) = 4.72, p = .317), ethnic groups (c2(4) = 2.53, p = .640) and weight category at the start of the intervention (c2(3) = 6.20, p = .102). CONCLUSIONS: This study contributes to the growing body of evidence demonstrating the efficacy of multicomponent school-based weight management interventions and demonstrates that such interventions can be successfully implemented as part of a wider healthy lifestyles service, without widening health inequalities.

Implementation fidelity of an Integrated Healthy Lifestyle Service: a process evaluation.

AIMS: The current study aimed to evaluate implementation fidelity of an Integrated Healthy Lifestyle Service (IHLS). METHODS: A pragmatic sample of 28 individual interviews and 11 focus groups were conducted. This resulted in a total of 81 (22 male) individuals comprising key stakeholders (n = 18), as well as intervention staff across senior management (n = 4), team lead (n = 14) and practitioner (n = 11) roles, and intervention clients (n = 34). RESULTS: A mixed degree of implementation fidelity was demonstrated throughout the five a priori fidelity domains of study design, provider training, intervention delivery, intervention receipt, and enactment. Stakeholders, staff and clients alike noted a high degree of intervention receipt across all services offered. Contrastingly, practitioners noted that they received minimal formal operational, data systems, clinical, and curriculum training as well as a lack of personal development opportunities. Consequently, practitioners reported low confidence in delivering sessions and collecting and analysing any data. A top-down approach to information dissemination within the service was also noted among practitioners which affected motivation and overall team morale. CONCLUSION: Results can be used to conceptualise best practices as a process to further strengthen the design, delivery and recruitment strategies of the IHLS.

Tree water-use strategies to improve stormwater retention performance of biofiltration systems.

Biofiltration systems are highly valued in urban landscapes as they remove pollutants from stormwater runoff whilst contributing to a reduction in runoff volumes. Integrating trees in biofilters may improve their runoff retention performance, as trees have greater transpiration than commonly used sedge or herb species. High transpiration rates will rapidly deplete retained water, creating storage capacity prior to the next runoff event. However, a tree with high transpiration rates in a biofilter system will likely be frequently exposed to drought stress. Selecting appropriate tree species therefore requires an understanding of how different trees use water and how they respond to substrate drying. We selected 20 tree species and quantified evapotranspiration (ET) and drought stress (leaf water potential; Ψ) in relation to substrate water content. To compare species, we developed metrics which describe: (i) maximum rates of ET under well-watered conditions, (ii) the sensitivity of ET and (iii) the response of Ψ to declining substrate water content. Using these three metrics, we classified species into three groups: risky, balanced or conservative. Risky and balanced species showed high maximum ET, whereas conservative species always had low ET. As substrates dried, the balanced species down-regulated ET to delay the onset of drought stress; whereas risky species did not. Therefore, balanced species with high ET are more likely to improve the retention performance of biofiltration systems without introducing significant drought risk. This classification of tree water use strategies can be easily integrated into water balance models and improve tree species selection for biofiltration systems.